What’s Causing Your Pelvic Pain?
By Alicia Armeli

Pelvic-Pain

In the United States alone, as many as nine million women between the ages of 15 and 50 years suffer from chronic pelvic pain.1 If you’re one of these women, you know just how frustrating it can be. Not only because you’re experiencing pain, but also because it can be a challenge to find what’s causing it. Although there are many explanations for female pelvic pain, research shows endometriosis and other gynecological conditions make up two-thirds of the cases.1

“When it comes to pelvic pain, we first look at things like a woman’s reproductive age because it can be one problem from adolescence to late teens versus if a woman is over 60,” explained Dr. Linda Bradley, Gynecologic Surgeon, Professor of Surgery, Vice Chair of OB/GYN & Women’s Health Institute, and Director of the Center for Menstrual Disorders, Fibroids, and Hysterscopic Services at the Cleveland Clinic in Cleveland, Ohio. “In general, conditions that cause pelvic pain could be adenomyosis, endometriosis, uterine fibroids, ovarian cysts, and sexually transmitted infections like gonorrhea or chlamydia.”

It’s nearly impossible for a woman to self-diagnose because, in several cases, other common symptoms like heavy menstrual bleeding are seen to coexist alongside pelvic pain. For example, adenomyosis and uterine fibroids are both conditions involving noncancerous growths that invade the uterine wall, causing heavy painful periods and pelvic pressure.

Pelvic pain and pressure can also be a symptom of a condition entirely unrelated to the uterus—as seen with ovarian cysts. Even though the growths described are specific to each disease, it’s important to receive proper examination, diagnosis, and treatment. Especially since pelvic pain, Dr. Bradley noted, might be extremely affected by ovarian cancer.

Pelvic pain—and heavy menstrual bleeding—can also occur when the uterine lining begins to grow outside the uterus, as seen with endometriosis. But just as important as the pain itself, Dr. Bradley noted, observing when the pain occurs during a woman’s cycle is a significant part of the puzzle.

“Endometriosis tends to be more cyclical,” Dr. Bradley clarified. “It’s associated with pelvic pain, but it seems to worsen around week two of the three during the menstrual cycle and then also a day or two after your period is over. So while there is some overlap there may be some distinguishing features based upon menstruation.”

To understand where your pain is coming from, seeking medical attention is a must. And still, some studies show that 20 percent of women don’t receive diagnostic testing despite their pain.1 Living with the pain without diagnosis and treatment could lead to infertility, as seen with pelvic inflammatory disease caused by chlamydia and gonorrhea infections.

Spreading from the vagina to the cervix, uterine lining, fallopian tubes, and ovaries—pelvic inflammatory disease can manifest with pelvic pain and other symptoms like vaginal discharge—but signs and symptoms can be subtle.

“Commonly, patients will come in and say, ‘I had pain last month, I’ve never had it before, now it’s back or it’s not going away and it’s impacting me in different ways,” Dr. Bradley shared. “If pain is persistent—don’t ignore it.”

When a woman experiences pelvic pain and reaches out for medical attention, knowing everything she can about her pain is a significant part of the diagnosis. This means keeping track of the type of pain, its severity, onset, location, and whether anything worsens it—such as exercise, sex, urinating, or even stress.

Dr. Bradley noted the importance of having access to all previous medical records and discussing any treatments that were tried in the past. Following this dialogue, a woman can expect a physical examination and diagnostic imaging—such as an MRI or ultrasound—to collect more information. Since each woman is different, further tests may be called for at the discretion of her doctor.

Gynecological conditions may be the culprit the majority of the time, yet other explanations for female pelvic pain like bladder complications, gastrointestinal issues, and disorders of the muscles and nerves can’t be ruled out.

What’s more, approximately one-third of pelvic pain cases lack a direct cause—which could lead to unnecessary surgery. Studies show between 25 and 40 percent of women who undergo hysterectomy for pelvic pain will still have symptoms after their surgery, suggesting that the cause of their pain was something else entirely.1

Depending on the condition, several treatment options are available. In addition to surgery, treatments include minimally invasive procedures, counseling, hormone therapy, pharmaceuticals to manage pain, and procedures to block nerve sensitivity.1

To help receive the right diagnosis and treatment, Dr. Bradley advises women “to notice everything about your pain because doctors are always specific. If you’re experiencing pelvic pain, it’s best to be seen by a doctor sooner rather than later.”

ABOUT THE AUTHOR Alicia Armeli is a Health Freelance Writer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering with her local animal shelter.

ABOUT THE DOCTOR Linda Bradley, MD is an internationally recognized gynecologic surgeon, professor of surgery, Vice Chair of OB/GYN & Women’s Health Institute, and Director of the Center for Menstrual Disorders, Fibroids, and Hysterscopic Services at the Cleveland Clinic in Cleveland, Ohio. As founder of the Celebrate Sisterhood program and recipient of the American College of Obstetricians and Gynecologists Pete and Weesie Hollis Community Service Award, Dr. Bradley is dedicated to empowering women to take charge of their health, embracing self-care, and creating positive change in the world.

REFERENCES

1. Apte, G., Nelson, P., Brismee, J., Dedrick, G., Justiz, R., & Sizer, P. S. (2011). Chronic female pelvic pain—part 1: clinical pathoanatomy and examination of the pelvic region. doi: 10.1111/j.1533-2500.2011.00465.x. Retrieved March 3, 2016, from
https://www.researchgate.net/profile/Patricia_Nelson3/publication/51168233_Chronic_Female_Pelvic_Pain-Part_1_Clinical_Pathoanatomy_and_Examination_of_the_Pelvic_Region/links/004635399dc562e557000000.pdf

Fibroid Recurrence After UFE: Who’s Most At Risk?
By Alicia Armeli

Fibroid-Recurrence

Uterine fibroid embolization (UFE) can provide nonsurgical long-term relief to women with symptomatic fibroids, but up to 18 percent of women who undergo the procedure will eventually experience symptom recurrence, reports a study in Obstetrics & Gynecology.1

Dr. Giovanna Tropeano and a team of researchers at Catholic University of the Sacred Heart in Rome, Italy, investigated the rate of symptom recurrence after UFE among 176 women with the goal of identifying factors that put women at a higher risk.

Results showed that the rate of symptom recurrence climbed from 3 percent at 1 year post-UFE to 7 percent at 3 years; 14 percent at 5 years; and 18 percent at 7 years. These results are lower than earlier studies that reported rates of symptom recurrence of up to 28 percent after 5 years.1

Specific factors were found to increase the risk of symptom recurrence. UFE was less likely to provide long-term relief if blood supply to the fibroids wasn’t blocked completely, if new fibroids grew after the procedure, or if other gynecologic conditions existed simultaneously. The authors also noted that in rare cases, despite a “technically successful procedure,” symptoms still recurred for unknown reasons. The risk of recurrence increased six-fold for women 40 years of age and younger.

“Younger women may be more likely to have blood supply to the fibroids from blood vessels in addition to the uterine arteries. FoFibroid Recurrence After UFE: Who’s Most At Risk?
r UFE to be successful at relieving symptoms, it requires that nearly all of the blood flow to the fibroid is stopped,” explained Dr. Meghal Antani, Interventional Radiologist and Medical Director at the Center for Interventional Medicine in Springfield, Va., who was not involved in the study. “Younger women may also have other conditions that cause very similar clinical symptoms of pain and bleeding like endometriosis.”

Uterine fibroids are noncancerous tumors that are most common among women in their 40s and early 50s.2 If younger women suffer from fibroids, these women might be at a higher risk of having a more severe form of the disease and, therefore, a higher risk of recurrence after treatment.1

Fibroid severity was seen to explain why women with a history of prior myomectomy, or surgical removal of fibroids, are almost four times more likely to experience symptom recurrence post UFE. Younger women also have more time until menopause which is when fibroids are seen to naturally shrink on their own, causing the numbers in this age group to be higher.1

Symptom recurrence is a risk, but clinical literature has also shown UFE to have a nearly 90 percent cure rate.3 And for the remaining women, symptom recurrence may happen gradually, which can offer temporary relief while also providing time before resorting to more invasive measures of treatment.

Some women may even be candidates to try embolization again. “If UFE is not successful the first time, then repeating the procedure may be successful if on a follow up MRI, the fibroids are shown to still have blood flow to them,” Dr. Antani told Ask4UFE. “This would suggest that there are other blood vessels supplying blood to the fibroids, such as branches of the ovarian arteries. If these other vessels are blocked again by UFE, then the patient may have greater benefit.”

If symptoms still recur, other options do exist. With any course of action, factors that need to be considered include age—and how close a woman is to the clinical benchmark of menopause— whether she wants to have children, and if she is open to interventions like surgery.

At this time, myomectomy—which has a comparable or even higher rate of recurrence than UFE, is the recommended fibroid treatment for women who want children.

“All of these factors are valid and should be considered. Myomectomy and hysterectomy are still options that a patient can consider if she undergoes UFE and it doesn’t work adequately,” Dr. Antani said. “In other words, undergoing UFE doesn’t always prevent a person from having a hysterectomy or myomectomy later, but those can still be used as back-up plans.”

ABOUT THE AUTHOR Alicia Armeli is a Health Freelance Writer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering with her local animal shelter.

ABOUT THE DOCTOR Meghal Antani is an interventional radiologist and Medical Director at the Center for Interventional Medicine in Springfield, VA. With 20 years of combined patient care and research, Dr. Antani’s other specialties include, but aren’t limited to, vascular radiology, minimally invasive treatments for women’s health, and interventional pain medicine. Dr. Antani is dedicated to improving the patient experience by working to create a treatment plan that fits each person individually.

REFERENCES

1. Tropeano, G., Di Stasi, C., Amoroso, S., Vizzielli, G., Mascilini, F., & Scambia, G. (2012). Incidence and risk factors for clinical failure of uterine leiomyoma embolization. Obstetrics & Gynecology, 120:269-276. doi: 10.1097/AOG.0b013e31825cb88e
2. Office on Women’s Health, U.S. Department of Health and Human Services. Uterine fibroids fact sheet. Retrieved March 19, 2016, from http://www.womenshealth.gov/publications/our-publications/fact-sheet/uterine-fibroids.html

McLucas, B., Voorhees Iii, W. D., & Elliott, S. (2015). Fertility after uterine artery embolization: a review. Minimally Invasive Therapy & Allied Technologies, 2: 1-7.

UFE Was the Answer to My Prayers
By Alicia Armeli

Gwen-Tyler

“My life is so wonderful,” said Gwen Tyler, a Corporate Paralegal who resides in Atlanta, Georgia. But this wasn’t always her story. Just three years ago, uterine fibroids were taking a mental, emotional, and physical toll on her everyday life. Unwilling to accept hysterectomy as a cure for her fibroids, she searched for other treatments and found uterine fibroid embolization (UFE) to be the non-surgical option she needed.

In 2013, Gwen started to experience long, heavy periods. Thinking it was normal, her bleeding didn’t concern her until 2014 when she became very anemic and began to lose her hair. “I couldn’t go anywhere because I was bleeding so heavily,” she recalled. “I got really depressed and so I spent most of my time at home because I was afraid to go out. I didn’t know where I would have an accident—it was very embarrassing. It was just taking the life right out of me.”

In August 2014, her gynecologist diagnosed her with uterine fibroids. Now understanding the cause of her bleeding, Gwen looked forward to treatment and relief. But even after having a myomectomy to remove her fibroids, her abnormal bleeding started again just four months later. Following further examination, her gynecologist found another fibroid—and this time recommended surgically removing her entire uterus. “[My gynecologist’s] treatment for fibroids was to have a hysterectomy, which was very upsetting to me at the time,” she explained. “I didn’t go back to him for treatment.”

For some, this may have seemed like a setback—but Gwen took it as an opportunity to explore her options. “I had prayed that I would get an answer for this, because the answer that my doctor gave me was unacceptable,” she said.

Like many women who are looking for alternatives to hysterectomy, Gwen didn’t learn about all of her options from her doctor—but from the media. “I was watching the television show, ‘The Doctors,’ and fortunately for me, Dr. Lipman was on that show that day,” she smiled. After watching Dr. John Lipman of Atlanta Interventional Institute explain the benefits of UFE, she knew she had to call and make an appointment.

Although excited at the prospect of a non-surgical cure, she was also concerned. With fibroids so large they were pushing her uterus into the upper part of her abdominal cavity, she wondered if she was even a candidate.

But after consulting with Dr. Lipman and meeting his staff, Gwen’s worries were a thing of the past. “I knew Dr. Lipman could help me—I just felt he was the answer to my problem for fibroids,” she said. “[His staff] at the office was very engaging. They made me feel very comfortable.”

Following UFE, Gwen described her recovery as amazing. With cramping only lasting one day after the procedure, she reported feeling like “a million bucks” and only needing ibuprofen to ease any discomfort. “The biggest problem I had was with my husband telling me that I needed to rest,” she laughed. “I had no pain at all—for me it was just wonderful.”

Gwen was in for another pleasant surprise. During a follow-up appointment scheduled in April 2015, she learned her fibroids had shrunk significantly and her uterus had moved back to its pre-fibroid position.

Without the bulk and bleeding her fibroids caused, Gwen felt like a whole new woman. “Life is so much more full, happy, and wonderful since I’ve had UFE,” she expressed. “I have a lot of energy. I get to go out with my friends and enjoy life like I did before I had fibroids.”

By sharing her story, Gwen hopes to show women with fibroids they aren’t alone and to encourage them to look beyond surgery. “In my research, I became aware that a lot of women have fibroids,” she said. “And that there are options other than hysterectomy.”

Can Acupuncture Relieve My Fibroid Symptoms?
By Alicia Armeli

acupuncture

For over 3,000 years acupuncture has been used to prevent and manage disease. Although originally practiced in ancient China as part of Traditional Chinese Medicine, acupuncture has become increasingly popular in the Western World. But can this millennia-old treatment alleviate symptomatic uterine fibroids?

In terms of Traditional Chinese Medicine, uterine fibroids are nothing new. Dating back to the third century BCE, healers referred to these noncancerous growths in primitive texts as a category of Zheng Xia—translated as masses in the uterus with a feeling of pain, fullness, and bleeding.1

Thousands of years later, uterine fibroids are still found to affect 20-80 percent of women by age 50.2 Even though the majority of fibroid cases show no symptoms, a small percentage of women suffer from this debilitating condition, leaving them to look for any and all available treatment options.

At the Beijing Traditional Chinese Medicine Hospital of the Capital Medical University in Beijing, China, Y. Zhang of the Department of Acupuncture and a team of researchers investigated the benefits and harms of acupuncture in women with fibroids.

Collecting studies from nine electronic databases, the team published their results in The Cochrane Collaboration.3 Overall, 106 studies were found—but none were included in the final literature review because all were lacking quality research and data.

The authors concluded that there currently isn’t high quality evidence available to support the efficacy of acupuncture in the treatment of uterine fibroids.

Despite collective data such as this, research like the Study of Pelvic Problems, Hysterectomy, and Intervention Alternatives (SOPHIA)4 shed light on acupuncture as a possible treatment option. V.L. Jacoby of the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco, studied 933 premenopausal women ages 31-54 years with symptomatic fibroids for an average of approximately 4 years.

Through annual interviews, Jacoby and her team gathered information about the use of fibroid treatments and compared data for women who underwent uterus-preserving surgery with those who didn’t.

At the end of the study, 36-43 percent of women who tried complementary alternative treatments, including the 15 percent who underwent acupuncture, found it to greatly improve symptoms.

The authors did not investigate the effects of acupuncture alone, but concluded that many women use complementary treatments and report significant improvement with few side effects.

It’s still not fully understood how alternative treatments like acupuncture improve symptoms, but theories do exist.

The idea surrounding acupuncture’s success is grounded in the belief that the needles penetrate specific points, stimulating meridians or energy pathways that flow throughout the body. This way, acupuncture helps the body to regulate and correct any energy blockages, leading it back to a balanced state.5

From a biological standpoint, these acupuncture points may stimulate the brain and the spinal cord to release chemicals that help the body to self-regulate, heal, and support overall well-being.5

How acupuncture may treat symptomatic fibroids is no different. Fibroids are thought to be stimulated by sex hormones and growth proteins. Researchers speculate that acupuncture can help regulate the glands and systems that play a role in producing and secreting these hormones.3

In 1996, the FDA approved acupuncture needles for single use by licensed practitioners. If proper protocol is followed, acupuncture has very few complications. However, because health complications have occurred from inappropriate needle use, the American Academy of Medical Acupuncture encourages finding a licensed acupuncture practitioner either through your primary doctor or national referral organizations.5

Currently, more quality long-term studies are needed to conclude if and how acupuncture works to treat symptomatic fibroids. Whether acupuncture’s success can be attributed to science or simply the placebo effect—it’s best to first discuss any and all alternative treatment options with your primary care provider.

ABOUT THE AUTHOR Alicia Armeli is a Health Freelance Writer and Photographer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering within her community.

REFERENCES

1.Zhou, J., & Qu, F. (2009). Treating gynaecological disorders with traditional Chinese medicine: a review. African Journal of Traditional, Complementary and Alternative Medicines, 6(4): 494-517.
2.Office of Women’s Health, U.S. Department of Health & Human Services. (2015). Uterine Fibroids Fact Sheet. Retrieved March 30, 2016, from http://www.womenshealth.gov/publications/our-publications/fact-sheet/uterine-fibroids.html
3.Zhang, Y., Peng, W., Clarke, J., & Liu, Z. (2010). Acupuncture for uterine fibroids (review). The Cochrane Collaboration. doi: 10.1002/14651858.CD007221.pub2. Retrieved March 29, 2016, from https://www.researchgate.net/profile/Zhishun_Liu/publication/41103940_Acupuncture_for_uterine_fibroids/links/00b7d537234444486a000000.pdf
4.Jacoby, V. L., Jacoby, A., Learman, L. A., Schembri, M., Gregorich, S. E., Jackson, R., & Kuppermann, M. (2014). Use of medical, surgical, and complementary treatments almon women with fibroids. European Journal of Obstetrics & Gynecology and Reproductive Biology, 182: 220-225. doi: 10.1016/j.ejogrb.2014.09.004
5.American Academy of Medical Acupuncture. (2016). NCCAM Acupuncture Information. Retrieved March 28, 2016, from
http://www.medicalacupuncture.org/For-Patients/Articles-By-Physicians-About-Acupuncture/NCCAM-Acupuncture-Information

Is Birth Control Necessary After UFE?
By Alicia Armeli

UFE_BirthControl

A widespread belief is that women no longer need to use birth control after having uterine fibroid embolization (UFE). Yet women wishing to conceive after UFE are able to have full-term pregnancies and give birth to healthy babies. In one particular study, 1 researchers looked at 44 women 40 years or younger that had UFE and indicated a desire for future childbearing. Out of the group, 48 percent of the women had successful pregnancies with term delivery of healthy babies.

“A common misconception is that women cannot become pregnant after UFE,” said Dr. Olga Brook MD, Vascular & Interventional Radiology and Abdominal Imaging Radiologist, Associate Director of CT Services, and Director of the International Visiting Observership Program in Interventional Radiology at Beth Israel Deaconess Medical Center, and Assistant Professor of Radiology at Harvard Medical School in Boston, Mass. “Studies show that women can become pregnant and can carry a pregnancy to term after UFE.”

UFE works by cutting off blood flow to the fibroids, causing these noncancerous uterine tumors to shrink. Following the procedure, symptoms like heavy menstrual bleeding are reduced significantly. Because of this, the majority of UFE patients experience lighter periods, and in some cases, menstruation may stop all together. But this doesn’t automatically mean a woman can’t get pregnant.

According to Dr. Brook, the disappearance of menstruation after UFE most frequently happens because the lining of the uterus temporarily becomes very thin. “In these cases, ovarian function is preserved,” she clarified. “Periods usually will return after a few months. And if this is the cause, women can certainly get pregnant.”

On the other hand, Dr. Brook added, 10 percent of women whose periods stop after UFE do so because of an unusual disruption in blood flow to the ovaries1 resulting in an early onset of menopause. These cases are uncommon and almost exclusively occur in women over the age of 45 years. When this occurs, pregnancy is no longer possible.

Pregnancy can happen after UFE, but it becomes a high-risk pregnancy, Dr. Brook continued. Documented complications after UFE include early pregnancy loss, abnormal placentation, and preterm delivery. Although associated with similar risks, myomectomy—the surgical removal of fibroids—is currently considered the gold standard of fibroid treatment for women wishing to conceive.

For women not wanting to become pregnant after UFE, Dr. Brook advised not counting on the procedure as a form of birth control. “UFE is a great minimally invasive way to treat fibroids. However, it will not prevent pregnancy,” she cautioned. “If pregnancy isn’t desired, it’s important to use the contraception method of your choice.”

ABOUT THE AUTHOR Alicia Armeli is a Health Freelance Writer and Photographer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering within her community.

ABOUT THE DOCTOR Olga Brook MD is a Vascular & Interventional Radiology and Abdominal Imaging Radiologist, Associate Director of CT Services, Associate Program Director of the Vascular and Interventional Radiology Fellowship, and Director of the International Visiting Observership Program in Interventional Radiology at Beth Israel Deaconess Medical Center, and Assistant Professor of Radiology at Harvard Medical School in Boston, Mass. In addition to her work in women’s health imaging and interventions, she strives to improve patient care, safety, and quality assurance in other areas of Diagnostic Radiology.

REFERENCES

1.McLucas, B., Voorhees Iii, W. D., & Elliott, S. (2015). Fertility after uterine artery embolization: a review. Minimally Invasive Therapy & Allied Technologies, 2: 1-7.

Advanced Fibroid Treatment Options

FibroidTreatment

Uterine fibroids are benign tumors of the uterus that affect up to 80% of women.1,2 Although hysterectomy is the most common treatment for uterine fibroids, women do not have to lose their uterus or go under the knife to relieve their symptoms – there are alternatives for those seeking less invasive options.

MedStar Georgetown University Hospital will be hosting a free “Advanced Fibroid Treatment Options” seminar on Wednesday, April 13, 2016, to discuss the different solutions available for fibroids. Featured guest speakers will include James Spies, MD, and Theresa Caridi, MD.

One such alternative treatment option is uterine fibroid embolization (UFE). “Uterine fibroid embolization is for those women who would like a definitive treatment for all their fibroids but would like to avoid an operation,” says Dr. James Spies MD MPH, Professor, Chairman and Chief of Service of the Department of Radiology at Georgetown University School of Medicine

Full event details for Georgetown’s “Advanced Fibroid Treatment Options” seminar and other Community Health Talks and events can be found at http://ask4ufe.com/events/.

  1. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003;188:100-7.
  2. Laughlin SK, Stewart EA. Uterine leiomyomas: individualizing the approach to a heterogeneous condition. Obstet Gynecol 2011;117:396-403.